The beat her pacemaker-maker skipped

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Nobody told Mavis Maurer her heart pacemaker might be faulty.
She only learned its maker, Guidant Corporation, had reported
technical problems after her son found a reference on the
internet.

Mrs Maurer is among about 500 Australian patients with
pacemakers from US-based Guidant who now need to have the devices
checked and possibly replaced, after a recall notice was issued two
weeks ago.

But nobody knows who or where they are because there is no
central registry of the life-saving implants.

Heart specialists asked federal and state governments last year
to fund a registry to keep track of the 13,000 pacemakers inserted
annually, but the proposal was rejected - despite the
Commonwealth's $600,000 funding of a comparable registry for joint
replacements.

Ken Hossack, the president of the Cardiac Society of Australia
and New Zealand, said that decision was inconsistent. Registering
each operation would be expensive, said Dr Hossack, a Queensland
cardiologist, but as well as being safer, it could save money.

"You can see whether or not new technologies work …
whether they are truly saving lives," he said.

Organised follow-up would become more important as the number
and complexity of implants increased, Dr Hossack said. The number
of defibrillator implants, which restart a stopped heart with an
electric shock, has increased fivefold to about 1000 annually in
the past decade, according to Australian Institute of Health and
Welfare figures. Artificial hearts are also starting to be
used.

Andrew Tonkin, the National Heart Foundation's chief medical
officer, said a registry should first apply to the more common
bypass and angioplasty procedures, extending later to implants.

"It is still on the agenda … it is a way of evaluating
long-term outcomes," Professor Tonkin said. Heart operations were
now considered for older and sicker people than in the past, he
said, and it was important to know whether people were truly
healthier.

Harry Mond, a cardiologist and pacemaker expert at the Royal
Melbourne Hospital, said about 1000 Australians had received the
Guidant devices - which in rare cases may fail because of a
defective seal - but it was likely only 500 were still alive. Of
those, 250 would have to be replaced anyway as their battery was
due to expire.

Associate Professor Mond said failure was so infrequent there
was no need for doctors to contact patients urgently and
individuals should not be concerned. He supported the idea of a
registry, but address changes and deaths would still hinder
follow-up.

A spokeswoman for the federal health department, Kay McNiece,
confirmed CSANZ's proposal had been rejected, but said officials
were still considering a heart surgery register. A registry could
be incorporated into an electronic health record linked to Medicare
registration, she said.